The Centers for Medicare and Medicaid Services (CMS) has issued a six-month, nationwide data-driven moratoria on new Medicare enrollment for hospices and home health agencies (HHAs) as part of a national anti-fraud campaign.

CMS said the ban will allow it “to temporarily halt the influx of new providers into these high-risk categories—a key source of fraudulent activity. Today’s move continues the Trump Administration’s crackdown on fraud, waste, and abuse in the Medicare program by stopping improper billing and preventing bad actors from entering the system.”

During the six-month moratoria, CMS said it will intensify targeted investigations, deploy advanced data analytics, and accelerate the removal of hospice and HHA providers from the Medicare program that are suspected of committing fraud.

In addition, the moratoria will apply to all applications for initial Medicare enrollment and certain changes in majority ownership, which are frequently used to obscure control by bad actors, CMS alleged.

The moratoria will not impact current enrollments, and existing providers can continue to deliver services to Medicare beneficiaries.

CMS’s announcement follows its earlier issuance of a similar moratorium to prevent fraudulent Medicare billing by certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) companies. “With three separate moratoria now in place, CMS has taken some of the most significant fraud prevention actions in the agency’s history,” CMS said.

Other Steps

Additional CMS work in the hospice and HHA areas has included:

• Revoking or deactivating hundreds of hospices and HHAs engaged in improper or fraudulent activity;

• Conducting nationwide hospice site visits to verify operations and identify suspicious activity;

• Heightened oversight of newly enrolled Medicare hospice providers in states with elevated fraud risk, including Arizona, California, Georgia, Ohio, Nevada, and Texas;

• Launching a new, publicly available hospice scoring system to increase transparency and identify providers with troubling patterns of utilization, quality, or compliance;

• Implementing enhanced enrollment screening measures for high-risk HHAs, including site verification of reported practice locations and fingerprinting-based background checks; and

• Expanding a demonstration project that allows pre- and post-claim review of HHA claims in Florida, Illinois, Oklahoma, Ohio, North Carolina, and Texas to stop improper payments before they occur.

Additional information on the Hospice and Home Health Agency moratoria can be found via the Federal Register at: https://www.federalregister.gov/

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